<html>
    <head>
        <title>Formulir Data Kartu Keluarga</title>
        <link href="<?php echo base_url('assets/css/formkk.css'); ?>" rel="stylesheet" type="text/css">
        <link href="<?php echo base_url('assets/js/jquery-ui.css'); ?>" rel="stylesheet" type="text/css" />
        <script type="text/javascript" src="<?php echo base_url('assets/js/jquery-1.9.1.js'); ?>"></script>
        <script type="text/javascript" src="<?php echo base_url('assets/js/jquery-ui.js'); ?>"></script>

        <script type="text/javascript">
            $(function() {
                $("#tgl_pembuatan").datepicker({changeMonth: true, changeYear: true});
            });
        </script>
    </head>
    <body>
        <form action="<?php echo base_url('kk/tambah'); ?>" method="post" enctype="multipart/form-data">
            <table width="471" border="0" align="center">
                <tr>
                    <td colspan="5" class="trheader"><strong>Formulir Data Kartu Keluarga</strong></td>
                </tr>
                <tr>
                    <td colspan="5" class="jeda">&nbsp;</td>
                </tr>
                <tr>
                    <td width="130">No. KK</td>
                    <td colspan="4"><input type="text" name="no_kk" id="no_kk" class="textinput" placeholder="3501062001053536"/></td>
                </tr>
                <tr>
                    <td width="130">Alamat</td>
                    <td colspan="4"><input type="text" name="alamat" id="alamat" class="textinput" placeholder="Jalan/Gang" /></td>
                </tr>
                <tr>
                    <td height="30">Dusun</td>
                    <td colspan="5"><input type="text" name="dusun" id="dusun" class="textinput" placeholder="Nama Dusun" /></td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td colspan="4">&nbsp;&nbsp;&nbsp;RT&nbsp;&nbsp;&nbsp;      
                        <input type="text" name="rt" id="rt" class="textinputdua" placeholder="Angka" />      RW&nbsp;&nbsp;&nbsp;
                        <input type="text" name="rw" id="rw" class="textinputdua" placeholder="Angka" /></td>
                </tr>
                <tr>
                    <td>Desa</td>
                    <td colspan="4"><input type="text" name="desa" id="desa" class="textinput" placeholder="Nama Desa" /></td>
                </tr>
                <tr>
                    <td>Kecamatan</td>
                    <td colspan="4"><input type="text" name="kecamatan" id="kecamatan" class="textinput" placeholder="Nama Kecamatan" /></td>
                </tr>
                <tr>
                    <td>Kabupaten</td>
                    <td colspan="4"><input type="text" name="kabupaten" id="kabupaten" class="textinput" placeholder="Nama Kabupaten" /></td>
                </tr>
                <tr>
                    <td>Propinsi</td>
                    <td colspan="4"><select name="idpropinsi" class="list">
                            <?php
                            if (isset($propinsi)) {
                                foreach ($propinsi->result() as $data_propinsi) {
                                    echo '<option value="' . $data_propinsi->idpropinsi . '">' . $data_propinsi->propinsi . '</option>';
                                }
                            }
                            ?>
                        </select></td>
                </tr>
                <tr>
                    <td>Kode Pos</td>
                    <td colspan="4"><input type="text" name="kodepos" id="kodepos" class="textinput" placeholder="Kodepos"/>
                        &nbsp;&nbsp;&nbsp;</td>
                </tr>
                <tr>
                    <td>Tanggal Pembuatan</td>
                    <td colspan="4"><input type="text" name="tgl_pembuatan" id="tgl_pembuatan" class="textinputdua" placeholder="Tanggal" /></td>
                </tr>
                <tr>
                    <td colspan="5">&nbsp;</td>
                </tr>
                <tr>
                    <td colspan="3">&nbsp;</td>
                    <td width="143"><input type="submit" name="tambah" id="tambah" value="Tambah" class="btn btn-large"/></td>
                  <td width="223">&nbsp;</td>
              </tr>
            </table>



        </form>
    </body>
</html>
